Sleep and Breathing

, Volume 20, Issue 1, pp 25–31 | Cite as

Relationship between surfactant proteins B and C and obstructive sleep apnea: is serum SP-B concentration a potential biomarker of obstructive sleep apnea?

  • Liang Shao
  • Nanfang Li
  • Xiaoguang Yao
  • Mulalibieke Heizati
  • Arikin Abdireim
  • Yingchun Wang
  • Zufeiya Abulikemu
  • Delian Zhang
  • Guijuan Chang
  • Ling Zhou
  • Jing Hong
  • Yongping Zhang
  • Jianqiong Kong
  • Xiangyang Zhang
Original Article



Surfactant proteins B and C are mainly synthesized, secreted by alveolar type II cells, and affected by hypoxia and mechanical stretches. We hypothesized that their serum levels might be altered by intermittent hypoxia and swing of intrathoracic pressure of obstructive sleep apnea (OSA).


Consecutive 140 middle-aged males, suspicious of OSA determined by polysomnography, were studied. Surfactant proteins B and C were determined by ELISA.


Surfactant protein B (41.39 ± 6.01 vs 44.73 ± 7.62 ng/L, p = 0.005), not C (32.60 ± 6.00 vs 32.43 ± 6.44 ng/L, p = 0.61), significantly lowered in moderate to severe OSA subjects than in non to mild OSA subjects. Severity of OSA is inversely correlated with serum surfactant protein B. Adjusting age, body mass index, and smoking history, compared to subjects with surfactant protein B (SP-B) ≥43.35 ng/L, those with SP-B <43.35 ng/L showed significantly increased 1.528-fold risk for moderate to severe OSA (p = 0.009), whereas no association between surfactant protein C and OSA was observed. Prevalence of moderate to severe OSA in lower SP-B group is higher than that in higher SP-B group (62.7 vs 38.4 %, p = 0.003). Serial and parallel tests on Epworth sleep scale (ESS) and SP-B evaluation can be complementary and prove helpful with high specificity (94.44 %) and sensitivity (84.48 %) to detect moderate to severe OSA.


Serum surfactant protein B, rather than C, is decreased in some individuals with moderate to severe OSA, compared to non to mild OSA subjects. Serum surfactant protein B might be a potential biomarker to diagnose OSA.


Obstructive sleep apnea Surfactant protein Biomarker 



Obstructive sleep apnea


Alveolar type II cells




Body mass index


Hemoglobin A1C


Fasting blood glucose


Surfactant proteins


Surfactant protein B


Surfactant protein C


Krebs von den Lungen-6


Apnea/hypopnea index


Lowest oxyhemoglobin saturation


Oxygen desaturation index of 3 %


Oxygen desaturation index of 4 %


Blood pressure


Epworth sleep scale


Positive predictive value


Negative predictive value



This study was supported by the National Natural Science Foundation of China (grant number: 81260017)

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Liang Shao
    • 1
    • 2
  • Nanfang Li
    • 2
  • Xiaoguang Yao
    • 2
  • Mulalibieke Heizati
    • 2
  • Arikin Abdireim
    • 1
    • 2
  • Yingchun Wang
    • 2
  • Zufeiya Abulikemu
    • 2
  • Delian Zhang
    • 2
  • Guijuan Chang
    • 2
  • Ling Zhou
    • 2
  • Jing Hong
    • 2
  • Yongping Zhang
    • 1
    • 2
  • Jianqiong Kong
    • 2
  • Xiangyang Zhang
    • 1
  1. 1.Graduate School of Xinjiang Medical UniversityUrumqiChina
  2. 2.The Center of Hypertension of the People’s Hospital of Xinjiang Uygur Autonomous RegionThe Center of Diagnosis, Treatment and Research of Hypertension in XinjiangUrumqiChina

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